OPHTE#(R-S•---X~,335~ Harnett County Department of Public Health 2 0 8 3 5
PERMIT # Operation Permit
New Installation ~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 't'1c O Fr-. E'(Lc~
Name: (owner) G-Y s ar> oN SUBDIVISION kA -VIE. LOT # 3(.t3
System Installer n t xE Q -P A Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas Deen mstanea in compliance with applicabie North Larohna General Statutes, Rules for Sewage Treaanent and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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rr:nmi cvnvuivns:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~I Other _i tR-_ ~,maes Septic Tank: 1040 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 50 feet ditches feet ditches a4-3o inches
French Drain Reouired: - hne'ar4eet
Authorized State Agent Q.,-, Date '71 fs
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